CASE REPORT Open Access

Biepicondylar fracture presenting with elbowdislocation: a case reportSavas Guner1*, Sukriye Ilkay Guner2, Mehmet Fethi Ceylan1, Gokay Gormeli3, Cemile Ayse Gormeli4

and Haci Onder1

Abstract

Introduction: Biepicondylar fracture of the elbow is very rare, and to date there have only been three reports ofthis injury and its treatment in the English scientific literature. This case report evaluates the surgical internal fixationof a biepicondylar fracture of the elbow with an associated dislocation.

Case presentation: We report the case of a 15-year-old Turkish girl with a biepicondylar fracture dislocation ofthe left elbow. Open reduction and an internal fixation operation were applied. There were no complications.

Conclusion: In these injuries, open reduction and internal fixation appear to be a good method to restore elbowstability and function.

IntroductionElbow fractures are quite common in the pediatric agegroup [1]. In a study of 400 consecutive elbow fracturesin children, medial epicondylar fracture was the thirdmost common fracture after supracondylar and lateralcondylar fractures [2]. However, biepicondylar fracturedislocation of the elbow is very rare, and to date therehave only been three reports of this injury and its treat-ment in the English scientific literature [2-4].In this case report, we evaluate the results of the sur-

gical treatment of a biepicondylar fracture of the elbowwith an associated dislocation by internal fixation.

Case presentationA 15-year-old Turkish girl came to our hospital afterfalling onto her outstretched left arm five days earlier.Before coming to our department, she was seen byanother medical institution and had been put in aposterior splint with no reduction maneuver beingattempted. Our patient reported severe pain in her elbowand a sensation that her left elbow was ‘out of place’.On physical examination, our patient’s elbow was

mildly swollen and tender to palpation over the lateral

and medial aspect. The range of motion of her elbowwas limited due to the pain and the elbow itselfwas grossly unstable. Her left upper extremity wasneurologically intact. The elbow joint was not obviouslydislocated but radiography showed the joint to be non-concentric and subluxated (Figure 1). There was an avul-sion fracture of her medial epicondyle and a lateralhumeral epicondyle. The fracture of the lateral epicon-dyle of her humerus was extended into the capitellum.Our patient was taken to the operating room. After theelbow dislocation was reduced under general anesthesia,an open reduction and internal fixation was applied tothe biepicondylar fracture (Figure 2). No complicationsoccurred during the surgery. Our patient’s arm wassplinted in a cast for four weeks and a nurse explainedto our patient how to care for the cast. After removingthe cast, our patient was recommended to undertakerange of motion exercises.

DiscussionFractures of the medial epicondyle are commonly causedby a valgus stress producing traction on the flexor-pronator tendon and subsequently on the medial epicon-dyle itself. The valgus stress may be produced by afall on the outstretched hand or by a fall on the elbow.Direct trauma is a less common cause of medial epicon-dylar injury [1]. Medial stability of the elbow depends onthe forearm flexors and the medial collateral ligament.

* Correspondence: gunersavas@hotmail.com1Department of Trauma and Orthopedic Surgery, Medical School of YuzuncuYil University, Van, TurkeyFull list of author information is available at the end of the article

JOURNAL OF MEDICALCASE REPORTS

© 2012 Guner et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.

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When the medial epicondyle is displaced, the collateralligament is completely relocated with the fracture partof the medial epicondyle. When the tightness of themedial collateral ligament decreases, medial instability ofthe elbow is likely to occur. Therefore, surgical treat-ment is recommended for patients with a displaced frac-ture of the medial epicondyle [5].Isolated lateral epicondyle fractures are not commonly

reported. Lateral epicondyle fracture is frequently causedby a serious varus force applied to the elbow and canoccur from a direct blow or avulsion forces from the

extensor muscles [2,6]. A reasonable explanation forthe mechanism of biepicondylar fractures is a fall onoutstretched hand, in which there is valgus stress at theelbow together with internal rotation of the humerusover the planted forearm and hand, which leads to trac-tion and avulsion forces on both epicondyles [2]. Biepi-condylar elbow fracture dislocation can cause grossinstability of the elbow [2]. If instability occurs, surgicalreduction and fixation of the epicondyle is an effectivemethod of treatment [7].

ConclusionsIn the medical literature, there is limited data availabledescribing biepicondylar fracture dislocation of theelbow in children [2-4]. In these injuries, open reductionand internal fixation appear to be a good method to re-store elbow stability and function. Orthopedic surgeonsshould also bear in mind dislocations in pediatric frac-tures in joint areas.

ConsentWritten informed consent was obtained from thepatient’s legal guardian for publication of this case reportand accompanying images. A copy of the written con-sent is available for review by the Editor-in-Chief ofthis journal.

Competing interestsThe authors declare that they have no competing interests.

Authors’ contributionsSG was the main author and performed the clinical assessment, surgery andfollow-up. HO performed the clinical assessment and the follow-up. GGperformed the bibliographic research. MFC performed the clinicalassessment and the surgery. SIG was a major contributor in writing themanuscript and performed the cast care. CAG performed the radiologicalassessment. All authors have read and approved the final manuscript.

Author details1Department of Trauma and Orthopedic Surgery, Medical School of YuzuncuYil University, Van, Turkey. 2School of Nursing, Yuzuncu Yil University, Van,Turkey. 3Department of Trauma and Orthopedic Surgery, Van Training andResearch Hospital, Van, Turkey. 4Department of Radiology, Van Training andResearch Hospital, Van, Turkey.

Received: 31 March 2012 Accepted: 22 June 2012Published: 31 August 2012

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5. Bede WB, Lefebvre AR, Rosman MA: Fractures of the medial humeralepicondyle in children. Can J Surg 1975, 18:137–142.

Figure 1 X-ray views of the left elbow. (A) Anteroposterior X-rayview of the left elbow (I: medial epicondyle avulsion fracture,II: lateral epicondyle displace fracture, III: humero-ulnar jointdislocation); (B) Lateral X-ray view of the left elbow shows wideningof the joint space.

Figure 2 Postoperative anteroposterior and lateral X-ray viewsof the left elbow.

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6. Rockwood CA, Green DP, Bucholz RW, Heckman JD: The elbow. In Fracturesin children. Volume 3. 7th edition. Edited by Beaty JH, Kasser JR. Philadelphia:Wolters Kluwer/Lippincott Williams & Wilkins; 2009:475–590.

7. Capo J, Khamsi B, Nourbakhsh A: Posterolateral instability of the elbow inan adolescent boy with a lateral epicondyle fracture: a case report. Hand2011, 6:71–75.

doi:10.1186/1752-1947-6-265Cite this article as: Guner et al.: Biepicondylar fracture presenting withelbow dislocation: a case report. Journal of Medical Case Reports 20126:265.

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